Although there is some overlap, research has shown that women use androgenic anabolic steroids (AAS) for reasons that are often quite different from those of men. Even more dissimilar are the risks and consequences associated with female steroid abuse. It is clear that AAS use is not equally as dangerous for everyone. For example, AAS are: less dangerous for adult male elite athletes, than their non-athletic counterparts; still more dangerous for teenage boys whose bodies are not yet fully developed; and by far the most dangerous for both women and girls, as the female body is simply not equipped for exogenous (external in origin) male hormones.

Steroids are synthetic derivatives of the naturally occurring male hormone testosterone. They not only possess an anabolic (muscle and strength building) effect, but are androgenic (affecting sexual characteristics) as well. To put it bluntly, steroids are used to make men, manlier. For this single reason steroids are far more potentially harmful to females than they are to males. When introduced to the female endocrine system, AAS create a serious jolt. For example, in sex reassignment treatment (a.k.a. sex changes) the goal is to provide the patient with the opposite gender’s sexual characteristics to fullest extent possible. With the exception of the internal and external genitalia, these characteristics are contingent upon the biological effects of the respective sex steroids. Therefore, (semi)synthetic sex steroids are indispensable tools in sex reassignment treatment, and the use of cross-gender hormone treatment is necessary to achieve the desired outcome (Hamburger, 1969; Leavitt et al., 1980). Thus, women who abuse AAS will necessarily experience significant changes in their secondary-sexual characteristics including clitoral enlargement, a deepening of the voice, increased facial hair and so forth.

Ironically, steroid abuse by women is not only dangerous, it’s unnecessary. Many women erroneously believe that since men already possess greater testosterone levels, and are made bigger and stronger with AAS, that they require considerably more of these drugs to achieve similar results. However, since muscle size and strength does not increase in a manner directly proportionate to the amount of male hormone within the body, this theory is categorically false. In fact, studies have shown that women get considerable anabolic benefit out of dosages that are only a fraction of those needed by men. Thus, even those women who detrimentally decide to risk their health by using male hormones have no business taking them in large quantities.

WHY DO WOMEN TAKE AAS?

There are many reasons women begin using anabolic steroids. Several female AAS users have muscle dysmorphia, a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Those who suffer from this condition tend to hold delusions that they are "skinny", “fat” or "too small" when they are often above average in musculature. Dysmorphia is sometimes referred to as bigorexia or reverse anorexia nervosa, and is a very specific type of body dysmorphic disorder. Muscle dysmorphia is NOT a simple obsession with working out or bodybuilding. To be clinically diagnosed as muscle dysmorphic, a person must exhibit symptoms of the ‘type’ and ‘degree’ outlined within the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and not merely be overly interested in their physique or engaging in fitness behaviors that other people would consider excessive. Some of the inclusion criterion for the disorder are:

Constantly examining themselves in a mirror

Becoming distressed if they miss a workout session or one of six meals a day

Becoming distressed if they do not receive enough protein per day in their diet

Taking potentially dangerous anabolic steroids

Neglecting jobs, relationships, or family because of excessive exercising

Having delusions of being underweight or below average in musculature

Other Reasons

Of course AAS provide tremendous performance enhancement benefits, and though men garner the bulk of such scandals, professional and amateur women athletes also administer them for this purpose. Although such abuse has gone largely unnoticed in mainstream society, this issue is becoming so prevalent that some organizations have taken overtly preventative measures. For example, cafepress.com markets a “Without Steroids Women's” t-shirt to those who remain and support drug free athletics.

Surprisingly, many women use steroids because the feel like a need to protect themselves, and victims of rape often begin abusing AAS. In a National Institute on Drug Abuse (NIDA) study of women weightlifters, twice as many of those who had been raped reported using anabolic steroids and/or another purported muscle-building drug, as compared to those who had not been raped. Moreover, almost all of those who had been raped reported a marked increase their bodybuilding activities after the attack, in belief that being bigger and stronger would discourage further attacks by making them intimidating or unattractive. In another study involving 75 female subjects, 10 reported being raped as their reason for using AAS to increase muscle strength and size (Gruber, Pope; 1999). The rape victims in most cases believed they would never be able to trust a man again and consequently replaced these relationships with bodybuilding activities. Of the 10 admitted rape victims, 5 said that prior to the experience they had no intention of ever using steroids and believed they were a sign of weakness and unwillingness to achieve goals through hard work.

NEGATIVE SIDE EFFECTS

As stated earlier the female body is simply not equipped for the administration of AAS. Steroids are very powerful messengers that signal cells to behave in specific ways, many of which never become outwardly visible making the exact extent of the harm unknown to the user. Although type, dosage and duration play significant roles in the severity of negative effects, even a one-time cycle (use over a specific time period) at very low doses can cause irreversible damage even well after the cycle is completed (SEE: “Excerpt from a true story”).

Physical

Adverse physical conditions can and do occur in women using anabolic steroids. In biology and medicine, ‘virilization’ refers to the development of secondary changes, or the set of anatomical structures and features unique to males and females that are not directly related (and therefore secondary) to the production of sex cells. Most virilization is produced by androgens, any natural or synthetic compound (including steroids) that stimulates or controls the development and maintenance of masculine characteristics. Some negative side effects are permanent and others go away, at least partially, when the drug is discontinued. Some of these side effects can include, but are not limited to, deepening of the voice, increased body hair (including the growth of dark facial hair), loss of scalp hair, liver or kidney damage, oily skin, acne, facial pore enlargement, clitoral enlargement, decreased breast size, and increased levels of LDL cholesterol.

Behavioral

While very few studies have assessed the relationship of androgens to aggression or violent behavior, those that have done so note a correlation between testosterone levels and observed aggression (Grimes, J. 2003). Scientists have attempted to test the strength of this association by administering high steroid doses and placebos to human volunteers. The subjects were then asking to report on their behavioral symptoms over periods of days and weeks. Three out of four of the high dose studies produced greater feelings of irritability and aggression in relation to the placebo group, but the effects appear to be highly variable across individuals. The fourth study did not have a significant effect. One possible explanation, according to the researchers, is that some but not all anabolic steroids increase irritability and aggression.

POSSIBLE HEALTH CONSEQUENCES
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HORMONAL SYSTEM

WOMEN

enlargement of the clitoris

excessive growth of body hair

MEN

infertility

breast development

shrinking of the testicles

BOTH SEXES

male-pattern baldness

scalp hair thinning

MUSCULOSKELETAL SYSTEM

short stature

tendon rupture

CARDIOVASCULAR SYSTEM

heart attacks

enlargement of the heart’s left ventricle

LIVER

cancer

peliosis hepatis

SKIN

acne and cysts

oily scalp

INFECTION

HIV/AIDS

hepatitis

PSYCHIATRIC EFFECTS

rage

delusions

mania

paranoia

confusion

A woman on AAS can experience mild to moderate mental instability. A recent study suggests that the mood and behavioral effects seen during AAS abuse may result from secondary hormonal changes. Aggressive singular or situational instances are often labeled ‘Roid Rage’, which is typified by overly irritable reactions (sometimes violently) toward what would otherwise be deemed small life stressors. It is sometimes accompanied by severe mood swings, and clinically related to hypomania (part of the manic-depressive cycle), bipolar disorder and paranoia.

Additionally, women tend to suffer from withdrawal symptoms including psychosis, depression, listlessness, apathy, loss of appetite, feelings of anxiety. A woman can become forgetful, distracted, and sometimes even confused about what she’s doing or how she is acting. Most of all she won't understand why such things are happening to her.

Physiological

Besides having mean serum testosterone levels around 30 times greater than normal, a woman will have a decrease in sex-hormone binding globulin (SHBG- a protein produced in the liver) (Malarkey, Strauss, Leizman, Liggett, Demers; 1991), a decrease in follicle-stimulating hormones, a decrease in circulating HDL-cholesterol, and a decrease in thyroid binding proteins. These ever changing hormone levels weaken and endanger a woman's immune system making her far more susceptible not only to infectious disease but even the common cold.

One study cited the possibility that AAS might inhibit the immunomodulatory and antiviral activities of androgens like DHEA (acts on adrenal glands to induce the production of corticosteroids and dehydroepiandrosterone) (Hughes, Rady, Smith; 1998). This study also indicated that steroids significantly inhibited the production of corticotrophin in blood lymphocytes immediately following a viral infection. Simply stated, they can cause the prevention of antibodies during sickness, and lead to altered immune reactions.

Cardiovascular risk factors include the alteration or diminishing of her glucose tolerance and hyperinsulinism (become resistant to insulin), a change in lipoproteins (carry cholesterol in blood) fraction which can cause cardiovascular disease and atherosclerosis (deposition of fatty substances onto inner walls of arteries causing blockage), increased triglyceride levels, hypertension (abnormally high blood pressure), changes in her myocardium (middle muscular layer of heart wall), and increased concentration levels of several different clotting factors. Cardiomyopathy (a typically chronic disorder of heart muscle that may involve hypertrophy and obstructive damage to the heart), myocardial infarction (localized death of the myocardium tissue usually leading to heart failure), heart attack, stroke, and cerebro-vascular accidents have all been causes in deaths where AAS abuse was implicated. Of course the liver, the body’s primary filtration system will come under attack as it has to accommodate the increased toxicity. Among the liver problems promoted are holestatic jaundice (failure of bile flow that causes yellowish pigmentation of skin, tissues, and body fluids), peliosis hepatis (blood-filled cysts develop on liver), hepatocellular hyperplasia (unusual increase of an epithelial parenchymatous cell called hepatocytes in the liver), and cancer. Secondary filters such as the kidneys and gallbladder also become more susceptible to disease.

Musculoskeletal system threats exist within teens (female and male). One such threat is the fusing of growth plates between bones, which effectively reduces one’s potential height resulting in shortened stature. Frequently, since muscle strength is increasing too rapidly for tendons and ligaments to keep up, both are weakened to the point of rupture, and experience increased healing times. Another skeletal threat of particular interest to women is that of osteoporosis which can result due to a steroid’s exhaustion of a woman’s blood circulating calcium (as well as other minerals) levels. When this occurs the body begins to leech stored calcium deposits directly from the bones leaving them brittle.

Reproductive system trouble is a given as the delicate balance of her hypothalamus-pituitary-gonadal axis becomes skewed due to increases in circulating testosterone and diminished estrogen activity. Additionally, the stark decline in estrogen and progesterone can result in the inhibition of follicle formation, ovulation, and an irregular menstrual cycle which can lead to amenorrhea (absence or suppression of the menstrual cycle). A study conducted with 9 female weightlifters showed all but 2 had menstrual abnormalities (Malarkey et al.; 1991). A woman also runs a very high risk of developing cervical and/or endometrical cancer and uterine atrophy, and she risks infertility with extended AAS use. A pregnant woman using steroids can literally damage her unborn child by retarding fetus growth, or increasing the chances of pseudohermanphroditism (both male and female physical body and character traits).

Infection is experienced by many abusers who inject AAS. Most are unaware of the dangers of surrounding unsanitary injection techniques such as failing to swab the site, or sharing and reusing needles. Furthermore, some steroid preparations are manufactured illegally under less than sterile conditions. The combination of these factors put abusers at risk for acquiring life threatening viral infections, such as HIV and hepatitis B & C. Abusers can also develop infective endocarditis, a bacterial illness which causes a potentially fatal inflammation of the inner lining of the heart. Bacterial infections often manifest themselves as abscess formations near or at injection sites, causing pain which is sometimes unbearable.

ADDITIONAL HAZZARDS FOR BODYBUILDERS

In January of 2000 McLean Hospital released a landmark study. Hospital researchers from the tiny town of Belmont, MA eight miles west of Boston, cited widespread AAS abuse and other performance-enhancing drugs in many women bodybuilders. Although this may not exactly seem like groundbreaking news, the study further uncovered evidence that many female bodybuilders suffer from eating disorders, as well as several other body image and psychiatric disorders.

The study, believed to be the first in-depth look at AAS use in female bodybuilders, was published in Psychotherapy and Psychosomatics. It involved 75 female athletes who had competed in at least one bodybuilding or fitness contest, or who had lifted weights in the gym five days or more per week for at least two years. As part of the investigation study participants, mostly from the Boston area, received psychiatric and medical evaluations. Of the 75 subjects, 25 reported current or past steroid use. Women in both the steroid using and no-steroid using groups reported use of other performance enhancing drugs such as ephedrine, which were used by 20 of the 25 steroid users and 21 of the 50 non-users.

Study author Amanda Gruber, MD, and researcher at McLean Hospital’s Biological Psychiatry Laboratory exclaimed, "Bodybuilding can be a dangerous activity for women who have or are at risk of developing eating or body image disorders because the bodybuilding community accepts as normal the compulsive dieting, self-preoccupation and concomitant substance abuse that are associated with these disorders." According to Gruber and Harrison Pope, MD, PhD, chief of McLean’s Biological Psychiatry Laboratory, the paper’s second author, “One of the most interesting findings of the study was the high prevalence of eating disorders and other psychiatric disorders in women bodybuilders in general. The first syndrome, dubbed by the researchers as "eating disorder, bodybuilder type (ED, BT)," is characterized by rigid adherence to a high-calorie, high-protein, low-fat diet eaten at regularly scheduled intervals. ED, BT was found in 55 of the 75 study subjects. Nontraditional gender role, the second syndrome identified in 55 of 75 study subjects, is characterized by a strong preference for stereotypical masculine clothing, occupations and games or pastimes, and a strong preference for male friends.” Sixty-five out of the 75 study subjects reported extreme dissatisfaction with their bodies in accord with the early described syndrome called "muscle dysmorphia" in which even bodybuilders in top physical condition feel small and weak. Gruber states, "These patterns of eating behavior, gender role behavior and body image disorder caused profound effects on the social and occupational functioning of women bodybuilders. We encountered women who held degrees in law, medicine or business, yet had abandoned these careers to pursue an all-consuming lifestyle of rigorous dieting and spending many hours at the gym," said Gruber.

When it comes to bodybuilding, if a woman doesn’t train hard following a regular program, using proper technique and doing so consistently over time, the use of anabolic drugs will only make a difference in her sexuality, not her figure or competitive potential.

US Department of Health and Human Services. Physical Activity and Health: A Report from the Surgeon General. Atlanta, GA: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996